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Perioperative hyperinsulinaemic normoglycaemic clamp causes hypolipidaemia after coronary artery surgery

C J Zuurbier1, F J Hoek, J van Dijk

  • 1Department of Anaesthesiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. c.j.zuurbier@amc.uva.nl

British Journal of Anaesthesia
|February 29, 2008
PubMed
Abstract

Insights

Glucose-insulin-potassium (GIK) therapy during cardiac surgery reduces harmful fatty acids and triglycerides, leading to lower lipid levels. This intervention helps manage metabolic changes after reperfusion, improving patient outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Metabolic Medicine
  • Intensive Care Medicine

Background:

  • Glucose-insulin-potassium (GIK) administration is proposed to prevent hyperglycemia and hyperlipidemia post-cardiac interventions.
  • Existing research primarily addresses hyperglycemia, with limited focus on lipid profiles and other metabolic substrates.
  • This study investigates lipid and substrate dynamics during and after on-pump coronary artery bypass grafting (CABG) under a hyperinsulinemic normoglycemic clamp.

Purpose of the Study:

  • To evaluate the impact of a hyperinsulinemic normoglycemic clamp on lipid metabolism and other substrates during and after on-pump CABG.
  • To determine if GIK administration mitigates adverse metabolic changes, particularly hyperlipidemia, in the perioperative period.
  • To provide a comprehensive analysis of substrate alterations beyond glucose during cardiac surgery recovery.

Main Methods:

  • A randomized controlled trial involving 44 patients undergoing on-pump CABG.
  • Patients were assigned to either a control group (n=21) or a GIK group (n=23) receiving a 26-hour hyperinsulinemic normoglycemic clamp.
  • Plasma levels of free fatty acids (FFA), total triglycerides (TG), VLDL, HDL, LDL, ketone bodies, and lactate were measured.

Main Results:

  • GIK significantly reduced free fatty acid (FFA) levels during early reperfusion and throughout the clamp period (75% reduction in AUC).
  • GIK decreased total triglycerides (TG) by 53% (AUC), primarily by reducing VLDL and HDL fractions, with no significant effect on LDL.
  • GIK prevented post-reperfusion increases in ketone bodies (44-47% AUC reduction) but did not influence lactate levels.

Conclusions:

  • Mild hyperlipidemia was transient, observed only during early reperfusion before heparin reversal.
  • The hyperinsulinemic normoglycemic clamp effectively induced hypolipidemia during the majority of the reperfusion phase post-cardiac surgery.
  • GIK administration demonstrates a significant role in modulating lipid and substrate metabolism, potentially improving outcomes in cardiac surgery patients.

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